40 routine tests and procedures may do more harm than good, medical experts say

Forget about routine blood screening, annual cardiac stress tests if you have no symptoms, and automatic x-rays for low back pain.

Under new recommendations from medical leaders across the country, doctors and their patients are being asked to “think twice” about a total of 40 tests, procedures and treatments that are overused and often unnecessary.

Under the Choosing Wisely Canada campaign, launched Wednesday in Ottawa, nine national medical organizations have each come up with lists of interventions that, according to definitive evidence, provide no benefit when used routinely.

Not only are these interventions not necessary, they can be harmful, warned Dr. Wendy Levinson, founder of the campaign and chair of the department of medicine at the University of Toronto.

“They detract from care by potentially exposing patients to harm, leading to more tests to pursue false positives and contributing to stress and inconvenience,” she told a teleconference, adding that unnecessary imaging can needlessly expose patients to radiation.

The lists have been a year in the making in a campaign modelled after one launched in the United States in 2012 under the same name. South of the border, it is estimated that up to 30 per cent of tests, treatments and procedures do not add value.

While saving money is not an official intent of the Canadian campaign, physicians involved behind the scenes say that benefit cannot be ignored.

On the hit list of interventions are routine annual blood tests for asymptomatic patients.

“Anything you order on a patient should be dictated or suggested by what the patient-presenting complaint or difficulty may be,” explained Dr. Lisa Bonang, chair of the Canadian Medical Association forum on general and family practice issues, one of the nine national medical organizations involved..

An example of where it would make sense to do regular blood tests is on diabetics to assess kidney function and cholesterol and blood sugar levels, Bonang said.

On its list of interventions that should be questioned, the Canadian Cardiovascular Society singles out annual stress cardiac imaging in asymptomatic patients during routine follow-up appointments.

“In low-risk individuals with no cardiac symptoms there isn’t any role for annual testing for routine follow-up,” said Dr. Heather Ross, vice-president of the society.

“Sometimes it’s a physician who may want to do a test that may not be necessary, and sometimes it’s a patient who comes in asking for a test that may not be necessary,” she added.

The Canadian Association of Radiologists has singled out imaging for low back pain on its list, noting that x-rays, CT scans and MRIs should only be ordered if red flags are present, such as neurological symptoms.

The overall list of unnecessary interventions is a work in progress and will grow, said Dr. Chris Simpson, president elect of the Canadian Medical Association, which is a lead partner in the campaign. He said 30 additional national medical organizations are on board and are developing their own individual lists.

Levinson said word of the campaign is getting out to physicians through medical journals and conferences, and to patients via handouts that will be made available in waiting rooms.

“We have a belief in society that ‘more is better.’ We buy big cars, big TV sets, we live in a culture of ‘more is better,’ and in medicine it’s just not the best. So we are trying to change that culture,” she said.